What should be done about the persistent running nose in a patient taking Latanoprost (prostaglandin F2 alpha analog) and artificial eye drops for their eye condition?

Management of Persistent Rhinorrhea in a Patient on Latanoprost

The running nose is most likely a known side effect of latanoprost, and you should reassure the patient while considering symptomatic management with nasal saline rinses or switching to an alternative prostaglandin analog if the symptom is bothersome enough to affect quality of life.

Understanding the Connection

Latanoprost and other prostaglandin F2α analogs can cause nasal symptoms as a recognized side effect, though this is not commonly emphasized in clinical practice:

• Systemic absorption occurs through nasolacrimal drainage, which can lead to mild systemic effects including nasal symptoms 1
• Proper administration technique reduces systemic absorption: Teach the patient eyelid closure or nasolacrimal occlusion (pressing on the inner corner of the eye) after instillation to minimize drainage into the nasal passages 2
• The patient should wait with eyes closed for 1-2 minutes after drop instillation to maximize ocular absorption and minimize systemic effects 2

Immediate Management Steps

First-Line Approach

• Optimize drop administration technique to reduce nasolacrimal drainage and systemic absorption 2
• Consider symptomatic treatment with preservative-free nasal saline rinses 2-3 times daily to manage rhinorrhea without interfering with glaucoma therapy
• Continue current therapy since the patient reports the eye drops are working well for IOP control 3

If Symptoms Persist or Worsen

• Consider switching to an alternative prostaglandin analog (bimatoprost or travoprost), as latanoprost is generally as effective as these alternatives, though bimatoprost may achieve slightly higher IOP reduction 4
• Evaluate for other causes of chronic rhinorrhea including allergic rhinitis, vasomotor rhinitis, or upper respiratory conditions that may be coincidental

Important Clinical Considerations

Do Not Discontinue Glaucoma Therapy

• Glaucoma damage is irreversible, making consistent daily use essential for preventing blindness 2
• Prostaglandin analogs like latanoprost provide the best IOP-lowering effect among all monotherapy regimens, reducing IOP by 22-39% over 1-12 months 5
• Do not delay or interrupt glaucoma medications while managing the rhinorrhea, as untreated glaucoma can lead to irreversible vision loss 3

Common Pitfalls to Avoid

• Do not assume the rhinorrhea is unrelated to the eye drops without first optimizing administration technique 2
• Avoid adding corticosteroid nasal sprays without careful consideration, as systemic absorption could theoretically affect IOP
• Do not overlook patient education about proper drop instillation, as many patients struggle with correct administration, particularly elderly patients 2

Monitoring and Follow-Up

• Reassess in 2-4 weeks after implementing proper administration technique to determine if rhinorrhea improves
• Document the side effect but emphasize that it is generally benign and does not indicate a serious problem 1
• Reinforce adherence to glaucoma therapy, as nearly 45% of glaucoma patients take fewer than 75% of prescribed doses, leading to inadequate IOP control 2